P - 80007' REQUEST FOR ELECTRICAL INSPECTION
Minnesola Board of Eiectricity
�� 1-396-117 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricify, s ta te. mn, us
Identify the work covered by this request:
LIREW ❑ REMODEL ❑ ADQITION ❑ REPAIF
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAIING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Unit � $25
OTHER ADDITIONAL FEES
� $.25 per Fixture
�atio� Boom � $4�
XCEL ENEROY SAVER'S SWITCH
to 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8o
Additional Insoection Trios � $20
�
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i nareoy oenny ma� i
R011GH IN
FlNALINSPECT�ON
TOTAL FEE
total fee is $20)
DATE
DATE
FOR OFFICE USE ONLY
1 II�III IIIII II�� I��� I��I �����
* 1 3961 1 72* ���
0�0 S�
Reque��ro2 Rough-in Inspection Required? ❑ Yes I�No InspecNon Other Than Rough-in: � Ready Now ❑ Will Cell
You musl cali the inspector when ready! Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesl inspection of the electrical work at:
Jab Addressl$t�@� Bo�OL �qyt� plq�. C�H FRIDLEY �p �8 �J'�32
61 esu � ri b � irt
Section Township Range Fire No. County ai�{(a
ooc��UDLEY EOANIN F 2 9��� Phona
Power Supplier Address
XCEL ENERGY
ElectricaH�nh,gct r�y� a��,r�� Contractor Lice� N�mb_ r3 Master License Number
4V 4 1 �1Unn
MaiGng 9� E�S 1 CKI'{I I LR[IPI�y��� PJNi141 �-*q I ti MH �i� i�
��itlp
Authoriz nature (C�pt� � ompany or Owner Perfortning Installation) Phone g51 848-2911
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E8-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW CAPY